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Warren CM, Bartell TR. Sociodemographic inequities in food allergy: Insights on food allergy from birth cohorts. Pediatr Allergy Immunol 2024; 35:e14125. [PMID: 38656700 DOI: 10.1111/pai.14125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/26/2024]
Abstract
A large and growing corpus of epidemiologic studies suggests that the population-level burden of pediatric FA is not equitably distributed across major sociodemographic groups, including race, ethnicity, household income, parental educational attainment, and sex. As is the case for more extensively studied allergic disease states such as asthma and atopic dermatitis epidemiologic data suggest that FA may be more prevalent among certain populations experiencing lower socioeconomic status (SES), particularly those with specific racial and ethnic minority backgrounds living in highly urbanized regions. Emerging data also indicate that these patients may also experience more severe FA-related physical health, psychosocial, and economic outcomes relating to chronic disease management. However, many studies that have identified sociodemographic inequities in FA burden are limited by cross-sectional designs that are subject to numerous biases. Compared with cross-sectional study designs or cohorts established later in life, birth cohorts offer advantages relative to other study designs when investigators seek to understand causal relationships between exposures occurring during the prenatal or postnatal period and the atopic disease status of individuals later in life. Numerous birth cohorts have been established across recent decades, which include evaluation of food allergy-related outcomes, and a subset of these also have measured sociodemographic variables that, together, have the potential to shed light on the existence and possible etiology of sociodemographic inequities in food allergy. This manuscript reports the findings of a comprehensive survey of the current state of this birth cohort literature and draws insights into what is currently known, and what further information can potentially be gleaned from thoughtful examination and further follow-up of ongoing birth cohorts across the globe.
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Affiliation(s)
- Christopher M Warren
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tami R Bartell
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Patrick M. Magoon Institute for Healthy Communities, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Jiang L, Zhang L, Xia J, Cheng L, Chen G, Wang J, Raghavan V. Probiotics supplementation during pregnancy or infancy on multiple food allergies and gut microbiota: a systematic review and meta-analysis. Nutr Rev 2024:nuae024. [PMID: 38502006 DOI: 10.1093/nutrit/nuae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
CONTEXT Probiotics show promise in preventing and managing food allergies, but the impact of supplementation during pregnancy or infancy on children's allergies and gut microbiota remains unclear. OBJECTIVE This study aimed to assess the effects of maternal or infant probiotic supplementation on food allergy risk and explore the role of gut microbiota. DATA SOURCES A systematic search of databases (PubMed, Cochrane Library, Embase, and Medline) identified 37 relevant studies until May 20, 2023. DATA EXTRACTION Two independent reviewers extracted data, including probiotics intervention details, gut microbiota analysis, and food allergy information. DATA ANALYSIS Probiotics supplementation during pregnancy and infancy reduced the risk of total food allergy (relative risk [RR], 0.79; 95% CI, 0.63-0.99), cow-milk allergy (RR, 0.51; 95% CI, 0.29-0.88), and egg allergy (RR, 0.57; 95% CI, 0.39-0.84). Infancy-only supplementation lowered cow-milk allergy risk (RR, 0.69; 95% CI, 0.49-0.96), while pregnancy-only had no discernible effect. Benefits were observed with over 2 probiotic species, and a daily increase of 1.8 × 109 colony-forming units during pregnancy and infancy correlated with a 4% reduction in food allergy risk. Children with food allergies had distinct gut microbiota profiles, evolving with age. CONCLUSIONS Probiotics supplementation during pregnancy and infancy reduces food allergy risk and correlates with age-related changes in gut microbial composition in children. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42023425988.
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Affiliation(s)
- Lan Jiang
- Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, China
| | - Lili Zhang
- Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, China
| | - Jiayue Xia
- Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, China
| | - Lei Cheng
- Department of Otorhinolaryngology and Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Guoxun Chen
- Department of Nutrition, University of Tennessee at Knoxville, Knoxville, TN, USA
| | - Jin Wang
- Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing, China
| | - Vijaya Raghavan
- Department of Bioresource Engineering, Faculty of Agricultural and Environmental Sciences, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
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Cheng IH, Yii CY, Yong SB. Growth outcomes and food allergies in children: Study limitations. Ann Allergy Asthma Immunol 2024; 132:403. [PMID: 38432786 DOI: 10.1016/j.anai.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 03/05/2024]
Affiliation(s)
- I-Han Cheng
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Chin-Yuan Yii
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Landseed International Hospital, Taoyuan, Taiwan; Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan.
| | - Su-Boon Yong
- Center for Allergy, Immunology, and Microbiome (AIM.), China Medical University Hospital, Taichung, Taiwan; Department of Allergy, Immunology, and Rheumatology (AIR), China Medical University Children's Hospital, Taichung, Taiwan; Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
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McPake B. Socio-economic gradients of health and health behaviors: From non-communicable diseases to breast feeding and back. Soc Sci Med 2024; 345:116535. [PMID: 38242745 DOI: 10.1016/j.socscimed.2023.116535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/19/2023] [Indexed: 01/21/2024]
Affiliation(s)
- Barbara McPake
- Nossal Institute for Global Health, | Melbourne School of Population and Global Health, Level 2, 32 Lincoln Square, Carlton 3053, Australia.
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Warren CM, Sehgal S, Sicherer SH, Gupta RS. Epidemiology and the Growing Epidemic of Food Allergy in Children and Adults Across the Globe. Curr Allergy Asthma Rep 2024; 24:95-106. [PMID: 38214821 DOI: 10.1007/s11882-023-01120-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE OF REVIEW Food allergies are immune-mediated, complex disorders, which are the source of increasing health concern worldwide. The goal of this review is to present an updated summary of the food allergy (FA) burden among children and adults across different populations, focusing on research from the past 5 years. RECENT FINDINGS FAs impact a growing number of global residents-particularly those residing in higher-income, industrialized regions. Moreover, growing epidemiologic evidence suggests that the population health burden of non-IgE-mediated FAs, such as food protein-induced enterocolitis syndrome, may also be higher than previously reported. FA is a complex trait that impacts infants, children, as well as adults across the globe. The population health burden of both IgE- and non-IgE-mediated FAs is likely to grow in the absence of rapid advances and widespread implementation of effective FA prevention and treatment interventions. Systematic epidemiological research initiatives are needed, both nationally and globally, to better understand and reduce the burden of these allergic diseases.
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Affiliation(s)
- Christopher M Warren
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Shruti Sehgal
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Scott H Sicherer
- Elliot and Roslyn Jaffe Food Allergy Institute, Division of Allergy and Immunology, Kravis Children's Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Ruchi S Gupta
- Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Bingemann TA, LeBovidge J, Bartnikas L, Protudjer JLP, Herbert LJ. Psychosocial Impact of Food Allergy on Children and Adults and Practical Interventions. Curr Allergy Asthma Rep 2024; 24:107-119. [PMID: 38261244 DOI: 10.1007/s11882-023-01121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE OF REVIEW IgE- and non-IgE-mediated food allergies are increasing in prevalence in children and adults worldwide. A food allergy diagnosis can be associated with a sense of overwhelm and stress and commonly has a negative impact on quality of life. RECENT FINDINGS While there is an increased recognition of the psychosocial effects of food allergy, the current research reflects the experience of mostly White, well-educated wealthier populations. Some studies have now explored the psychosocial impact among other populations; however, further study is needed. It is important that physicians and allied health professionals screen for the potentially negative psychosocial effects of food allergy and provide education to promote safety and self-efficacy at each visit; however, time may be a limiting factor. Numerous validated questionnaires are now available to help assess the psychosocial impact of food allergies. Allergy-friendly foods are typically more expensive, and thus, it is imperative that physicians screen for food insecurity as well. Educational resources should be offered regarding living well with food allergies at each visit. For patients and families experiencing anxiety or food allergy burden that is difficult to manage, referral to a mental health provider should be considered. Resources regarding programs to help accessing safe foods should also be available. Further research is needed among diverse populations focusing on interventions to best support patients and families with food allergy.
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Affiliation(s)
- Theresa A Bingemann
- Departments of Allergy, Immunology and Rheumatology and Pediatric Allergy and Immunology, University of Rochester School of Medicine, 601 Elmwood Ave, Box 695, Rochester, NY, 14642, USA.
| | - Jennifer LeBovidge
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lisa Bartnikas
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB, Canada
- George Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Linda J Herbert
- Division of Psychology &, Behavioral Health, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA
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Sansweet S, Rolling C, Ebisawa M, Wang J, Gupta R, Davis CM. Reaching Communities Through Food Allergy Advocacy, Research, and Education: A Comprehensive Analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:310-315. [PMID: 38151118 DOI: 10.1016/j.jaip.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 12/29/2023]
Abstract
This article explores the multifaceted approach of food allergy (FA) advocacy, research, and education to address the diverse challenges associated with FA, such as disparities in socioeconomic status, food security, quality of life, and the overall burden of the disease. Advocacy initiatives are instrumental in driving policy changes, raising public awareness, and directing substantial research funding, with a focus on reducing disparities. They have influenced allergen labeling regulations and improved access to epinephrine, emphasizing the importance of school-based management plans, especially in underserved communities. Research in FA informs medical practices and offers them hope for improved treatments. Recent breakthroughs in peanut allergy prevention and oral immunotherapy trials exemplify the potential for advancements while highlighting the need to address disparities in health care access. Education is a critical tool for prevention, raising awareness, and reducing the risk of allergic reactions. Efforts should be tailored to reach marginalized communities, particularly in schools where education on FA management is essential. Collaborating directly with communities is imperative to ensure inclusivity and address disparities. Barriers such as mistrust, language and cultural differences, and lack of diversity among researchers must be overcome to encourage diverse participation in research studies. This article concludes by emphasizing the significance of a comprehensive approach to FA research that prioritizes equity and inclusivity. The call to action highlights the need for global initiatives to reshape the landscape of FA care and address disparities in health care access and outcomes.
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Affiliation(s)
- Samantha Sansweet
- Center for Food Allergy and Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Corwin Rolling
- Center for Food Allergy and Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Julie Wang
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ruchi Gupta
- Center for Food Allergy and Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, Ill; Department of Pediatrics and Medicine at Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital, Chicago, Ill
| | - Carla M Davis
- Division of Immunology, Allergy, and Retrovirology, Baylor College of Medicine, Houston, Texas; Texas Children's Hospital Food Allergy Program, Texas Children's Hospital, Houston, Texas.
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Cook EE. Anthropological and sociological perspectives on food allergy. Clin Exp Allergy 2023; 53:989-1003. [PMID: 37649424 DOI: 10.1111/cea.14387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 09/01/2023]
Abstract
This review explores the anthropological and sociological literature on food allergy and identifies four primary areas of research to date. The first explores the relationality and management of risk, uncertainty and stigma among parents and sufferers of food allergies. The second analyses the influence of intersectionality, specifically the effects of class, gender, race/ethnicity and disability on experiences of food allergy. The third discusses diagnostic difficulties and the impact these have on legitimacy and believability, both in the context of clinician-patient relations and in managing food allergies in public spaces. The fourth explores the ethics and uncertainties in food allergy treatments and how scientific knowledge of emerging treatments is constructed. This body of research illustrates that although an individual disease, food allergy experiences are significantly affected by socio-cultural structures, institutions, ideologies and discourses. The review concludes with four primary recommendations. First, there should be more incorporation of anthropological or sociological methodologies and perspectives into studies of food allergy. Second, studies are needed from more countries exploring lived experience of food allergy. Third, research on food allergy needs to incorporate an analysis of intersectional factors such as gender, class and race/ethnicity, and should explore the experiences of minority populations. Fourth, more research is needed on the interactions between biomedicine and local systems of knowledge, as well as the factors that shape what treatments become available, for whom it becomes available, experiences of treatment and aspects (including biases) that influence patient-clinician interactions.
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Affiliation(s)
- Emma E Cook
- Modern Japanese Studies, Hokkaido University, Sapporo, Japan
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Schultz F, Warren CM, Chehade M, Cianferoni A, Gerdts J, Groetch M, Gupta RS, Strobel MJ, Upton JEM, Venter C, Waserman S, Nowak-Wegrzyn A. When Supplemental Formula Is Essential: Overcoming Barriers to Hypoallergenic Formula Access for Patients With Food Allergies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2686-2692. [PMID: 37182567 DOI: 10.1016/j.jaip.2023.04.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/16/2023]
Abstract
For food-allergic patients, hypoallergenic formulas (HFs) are medically indicated, often a primary component of the diet and essential for patient safety, health, nutrition, and overall well-being. Yet, food allergy is not included among the conditions mandated for coverage under federal health programs and private health insurance. The 2022 infant formula crisis has affected many North American families and has particularly influenced patients with food allergies who rely on a limited number of safe HF brands to safely meet their nutritional needs for growth and development. The current formula shortage further highlights the longstanding difficulties faced by families with food allergies in accessing HF. Within this context, this article focuses on chronic barriers faced by patients with food allergies in accessing HF and proposes potential solutions. Legislation is desperately needed to address HF affordability through changes in insurance reimbursement and disparities in access to HF among individuals with food allergy.
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Affiliation(s)
| | - Christopher Michael Warren
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Mirna Chehade
- Mount Sinai Center for Eosinophilic Disorders, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY; Mount Sinai Center for Eosinophilic Disorders, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Antonella Cianferoni
- Children's Hospital of Philadelphia, Division of Pediatric Allergy and Immunology, University of Pennsylvania School of Medicine, Philadelphia, Pa
| | | | - Marion Groetch
- Jaffe Food Allergy Institute, Division of Pediatric Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ruchi S Gupta
- Center for Food Allergy and Asthma Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Mary Jo Strobel
- American Partnership for Eosinophilic Disorders, Atlanta, Ga
| | - Julia E M Upton
- Division of Immunology and Allergy, Department of Paediatrics, Hospital for Sick Children, Temerty School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Carina Venter
- Children's Hospital Colorado, University of Colorado, Denver, Colo
| | - Susan Waserman
- Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
| | - Anna Nowak-Wegrzyn
- Hassenfeld Children's Hospital, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY; Department of Pediatrics, Gastroenterology, and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
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Leeds S, Nowak-Wegrzyn A. Defining socioeconomic and racial disparities in food allergy: The time is now. Ann Allergy Asthma Immunol 2022; 129:391-392. [PMID: 36155692 DOI: 10.1016/j.anai.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 10/14/2022]
Affiliation(s)
| | - Anna Nowak-Wegrzyn
- Department of Pediatrics, Hassenfeld Children's Hospital, NYU R. Grossman School of Medicine, New York, New York; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Polan.
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